Editorial: Trust GPs to make referral decisions

A Devon LMC motion, put forward but not discussed at last month's LMCs conference in York, called for a government review of whether referral management centres are value for money.

Our investigation on pages 29 and 30 in this issue finds that referral management is growing in popularity among CCGs struggling with ever tighter resources.

Using Freedom of Information requests and results from 182 CCGs, GP found that more than a quarter of CCGs had a referral management centre, with a fifth of these emerging since CCGs took control of commissioning.

In a dramatic indication of quite how widespread the practice is, our figures suggest one in six GP referrals in England now pass through a referral management centre.

Of most concern is that our investigation found 36% of CCGs with these centres reported errors in processing referrals. For more opinion on this investigation, go to our sister site, Inside Commissioning, at insidecommissioning.co.uk

Such errors could expose GPs to potentially serious medico-legal risks. For more practical help from the MDU about how to deal with referral management centres, go to our sister site Medeconomics, at medeconomics.co.uk

Perhaps most worrying is the workload implications of such centres for GPs. A total of 4% of referrals seen by the centres were returned to GPs for administrative reasons, including insufficient information, missing attachments and not fulfilling referral criteria.

GP acknowledges that the centres offer some educational benefits for referrers, but agrees with the GPC that peer review and targeted education with local guidelines are likely to be more effective than referral management centres.

The problem is that the centres undermine GPs' professionalism and risk delaying patient care.

A government review of the centres' value for money is unlikely, because the coalition will insist it is for CCGs to make such decisions locally.

GP would like to see more CCGs placing trust in their GPs to make decisions, without interference from referral management centres.

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